Individual
MARY ELIZABETH SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
4039 ROUTE 219, SUITE 101, SALAMANCA, NY 14779-9625
(716) 945-0361
Mailing address
515 MAIN ST, OLEAN, NY 14760-1513
(716) 945-0361
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
F3020031
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000560328002
BLUE CROSS
NY
05
—
0300F302003
—
NY
Enumeration date
11/01/2006
Last updated
07/09/2007
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